Prolonged Mechanical Ventilation After Lung Transplantation—A Single-Center Study

Hadem, Johannes; Gottlieb, Jens; Seifert, Diana; Fegbeutel, Christine; Sommer, W.; Greer, Mark; Wiesner, Olaf; Kielstein, Jan T.; Schneider, Andrea; Ius, F.; Fuge, Jan; Kühn, Christian; Tudorache, I.; Haverich, Axel; Welte, Tobias; Warnecke, G.; Hoeper, Marius M.

doi:10.1111/ajt.13632

Cited by 28 publications

(27 citation statements)

References 30 publications

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“…21,22 The potential etiology of voice and swallowing complications in this patient population is poorly understood and has received little attention in the literature. Cardiothoracic transplant surgery and the post-operative course are inherently complex and can involve (1) compromised respiratory function, (2) prolonged intubation, [23][24][25][26] (3) damage to the recurrent laryngeal nerve (RLN), 10,14,27 (4) intensive care unit acquired weakness, 28 (5) alterations to neurological status 9,28 and (6) chronic gastro-oesophageal reflux. [29][30][31] All these factors are known to have a direct association with swallowing and voice dysfunction.…”

mentioning

confidence: 99%

Swallowing and laryngeal complications in lung and heart transplantation: Etiologies and diagnosis

Black

Novakovic

Plit

et al. 2021

The Journal of Heart and Lung Transplantation

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mentioning

confidence: 99%

Swallowing and laryngeal complications in lung and heart transplantation: Etiologies and diagnosis

Black

Novakovic

Plit

et al. 2021

The Journal of Heart and Lung Transplantation

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“…PMV has been variously defined in previous studies as exceeding 24 h ( 28 ), 48 h ( 21 ), 72 h ( 17 ), 7 days ( 18 ), or 21 days ( 29 ) of mechanical ventilation in accordance with previous clinical guidelines, clinical experience or the 90th percentile of the duration of mechanical ventilation for the cohort. We tried to use statistical methods to find the cutoff where the hazard ratio of p-LOHS increased steeply, which was 48 h. The PMV incidence (50.3%) in our study was significantly higher than previous studies for various cardiothoracic surgeries, which may be due to the following reasons.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Prolonged Mechanical Ventilation After Pulmonary Endarterectomy: 7 Years' Experience From an Experienced Hospital in China

et al. 2021

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Background: Prolonged mechanical ventilation (PMV) is common after cardiothoracic surgery, whereas the mechanical ventilation strategy after pulmonary endarterectomy (PEA) has not yet been reported. We aim to identify the incidence and risk factors for PMV and the relationship between PMV and short-term outcomes.Methods: We studied a retrospective cohort of 171 who undergoing PEA surgery from 2014 to 2020. Cox regression with restricted cubic splines was performed to identify the cutoff value for PMV. The Least absolute shrinkage and selection operator regression and logistic regressions were applied to identify risk factors for PMV. The impacts of PMV on the short-term outcomes were evaluated.Results: PMV was defined as the duration of mechanical ventilation exceeding 48 h. Independent risk factors for PMV included female sex (OR 2.911; 95% CI 1.303–6.501; P = 0.009), prolonged deep hypothermic circulatory arrest (DHCA) time (OR 1.027; 95% CI 1.002–1.053; P = 0.036), increased postoperative blood product use (OR 3.542; 95% CI 1.203–10.423; P = 0.022), elevated postoperative total bilirubin levels (OR 1.021; 95% CI 1.007–1.034; P = 0.002), increased preoperative pulmonary artery pressure (PAP) (OR 1.031; 95% CI 1.014–1.048; P < 0.001) and elongated postoperative right ventricular anteroposterior dimension (RVAD) (OR 1.119; 95% CI 1.026–1.221; P = 0.011). Patients with PMV had longer intensive care unit stays, higher incidences of postoperative complications, and higher in-hospital medical expenses.Conclusions: Female sex, prolonged DHCA time, increased postoperative blood product use, elevated postoperative total bilirubin levels, increased preoperative PAP, and elongated postoperative RVAD were independent risk factors for PMV. Identification of risk factors associated with PMV in patients undergoing PEA may facilitate timely diagnosis and re-intervention for some of these modifiable factors to decrease ventilation time and improve patient outcomes.

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“…Prolonged ventilation, defined in one study as !21 days, has been associated with much poorer 1-year survival rates of around 60%. 83 During the subsequent 11 months, infection supersedes graft failure 2:1, which together encompass almost half of all deaths. 1 These and other common early complications are outlined in ►Table 2.…”

Section: Early Postoperative Care and Rehabilitation In Copd Recipientsmentioning

confidence: 99%

Chronic Obstructive Pulmonary Disease and Lung Transplantation

Greer

Welte

2020

Semin Respir Crit Care Med

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Lung transplantation (LTx) has been a viable option for patients with end-stage chronic obstructive pulmonary disease (COPD), with more than 20,000 procedures performed worldwide. Survival after LTx lags behind most other forms of solid-organ transplantation, with median survival for COPD recipients being a sobering 6.0 years. Given the limited supply of suitable donor organs, not all patients with end-stage COPD are candidates for LTx. We discuss appropriate criteria for accepting patients for LTx, as well as contraindications and exclusionary criteria. In the first year post-LTx, infection and graft failure are the leading causes of death. Beyond this chronic graft rejection—currently referred to as chronic lung allograft dysfunction—represents the leading cause of death at all time points, with infection and over time malignancy also limiting survival. Referral of COPD patients to a lung transplant center should be considered in the presence of progressing disease despite maximal medical therapy. As a rule of thumb, a forced expiratory volume in 1 second < 25% predicted in the absence of exacerbation, hypoxia (PaO2 < 60 mm Hg/8 kPa), and/or hypercapnia (PaCO2 > 50 mm Hg/6.6 kPa) and satisfactory general clinical condition should be considered the basic prerequisites for timely referral. We also discuss salient issues post-LTx and factors that impact posttransplant survival and morbidity such as infections, malignancy, renal insufficiency, and complications associated with long-term immunosuppression.

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Prolonged Mechanical Ventilation After Lung Transplantation—A Single-Center Study

Cited by 28 publications

References 30 publications

Swallowing and laryngeal complications in lung and heart transplantation: Etiologies and diagnosis

Swallowing and laryngeal complications in lung and heart transplantation: Etiologies and diagnosis

Risk Factors for Prolonged Mechanical Ventilation After Pulmonary Endarterectomy: 7 Years' Experience From an Experienced Hospital in China

Chronic Obstructive Pulmonary Disease and Lung Transplantation

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